Chapter 15 Vital Signs

15:1 Measuring and Recording Vital Signs (VS) Record information about the basic body conditions Abnormalities from homeostasis Main vital signs (VS) Temperature Pulse Respiration Blood pressure HOMEOSTASIS – the ideal health sate in the human body

Other Assessments Pain—patients asked to rate on scale of 1 to 10 (1 is minimal and 10 is severe)

Other Assessments Color of skin Pallor Cyanosis Jaundice Erythema Ecchymosis

Other Assessments Size of pupils and reaction to light ANISOCORIA – unequal pupils

Other Assessments Level of consciousness

Other Assessments Response to stimuli

Vital Sign Readings Accuracy is essential Report abnormality or change Must know how to accomplish task with various equipment Never guess or report false readings Report abnormality or change Severe abnormalities indicate life-threatening conditions If unable to get reading, ask another person to check

15:2 Measuring and Recording Temperature Temperature: Measures balance between heat lost and heat produced in the body Thermal activity Heat produced by metabolism of food and by muscle and gland activity Heat lost through perspiration, respiration, and excretion

15:2 Measuring and Recording Temperature Conversion between Fahrenheit and Celsius temperature F C: C = (F - 32) x (5/9 or 0.5556) C F: F = (C x 9/5 or 1.8) + 32 Practice: 102o F to C 212o F to C 19o C to F 37o C to F 102F = 102 - 32 = 70 x .5556 = 38.9 C 212F = 212 – 32 x .5556 = 100.0 C 19C = 19 x 1.8 = 34.2 + 32 = 66.2 F 37C = 37 x 1.8 + 32 = 98.6 F

Variations in Body Temperature Normal range 97-100o F, 36.1-37.8o C Causes of variations Size/shape of individual, time of day, part of body, metabolic activity Accelerated body processes = higher body temperature Lower body processes = lower body temperature Morning = LOWER temperature as body has rested Evening = HIGHER after muscular activity

Variations in Body Temperature Temperature measurements — oral, rectal (often used on infants/children), axillary or groin, aural, and temporal Normal: Oral: 98.6o F Axillary: 97.6o F Rectal: 99.6o F Aural/Temporal: no normal range

Variations in Body Temperature Abnormal conditions affecting temperature Increase: Illness and infection Exercise, excitement, fear High environmental temperatures Decrease: Starvation or fasting Sleep Sedation Mouth breathing Cold environmental temperatures

Variations in Body Temperature Abnormal conditions Hypothermia: body temperature < 95o F Fever: elevated above 101o F Pyrexia, Febrile, Afebrile Hyperthermia: body temperature > 104o F Fevers are usually caused by infection or injury Pyrexia = fever Febrile = fever is present Afebrile = no fever present

Thermometers Clinical thermometers Glass: contains mercury, analog Electronic: digital reading, quicker results Tympanic: use infrared energy Temporal: measures temporal artery Plastic or paper: disposable Reading thermometers and recording results Read in 1o increments, labeled by site R, Ax,, A, 986 On a thermometer each short line represents 0.2 (two-tenths) of a degree. Orally it does not need to indicate it. It is assumed it is an oral reading R = Rectal Ax = Axillary A = Aural (continues)

Thermometers (continued) Avoid factors that could alter or change temperature Examples??? Cleaning glass clinical thermometers Clean with alcohol wipe or soap/cool water Paper/plastic sheath on glass thermometer Used to prevent transmission of disease Dispose of properly Still wipe with alcohol pad Examples = eating, drinking, smoking in the last 15minutes

15:3 Measuring and Recording Pulse Pulse: Pressure of the blood pushing against the wall of an artery as the heart beats and rests (continues)

15:3 Measuring and Recording Pulse Major arterial or pulse sites Temporal Carotid Brachial Radial Femoral Popliteal Dorsal Pedal (continues)

15:3 Measuring and Recording Pulse Must note 3 different factors of the pulse: Pulse rate (beats per min) Pulse rhythm (regular or irregular) Pulse volume (strong, weak, thready, bounding) (continues)

15:3 Measuring and Recording Pulse Pulse rate – adult 60-100 bpm, varies Bradycardia: slow pulse rate, < 60 bpm Tachycardia: fast pulse rate, >100 bpm Pulse rhythm – spacing between beats Regular vs. irregular Arrythmia: abnormal heart rhythm Pulse volume – strength/intensity of the pulse Strong vs. weak, thready, bounding (continues)

Measuring and Recording Pulse Factors that change pulse rate Increase: Exercise Stimulant drugs Excitement Fear Fever Shock Nervous tension Decrease: Sleep Depressant drugs Heart disease Coma Physical training

Measuring and Recording Pulse (continued) Basic principles for taking radial pulse: Patient positioned comfortably, palm down Use tip of index/middle fingers to locate pulse on thumb side of wrist First beat counted starts with zero 10 sec x 6 15 sec x 4 30 sec x 2 60 sec

Measuring and Recording Pulse (continued) Recording information: Include rate, rhythm, volume Example: P 82 regular and strong (rate)(rhythm)(volume)

15:4 Measuring and Recording Respirations Respiration: Measures the breathing of a patient Process of taking in oxygen and expelling carbon dioxide from the lungs and respiratory tract (continues)

15:4 Measuring and Recording Respirations One respiration: one inspiration (breathing in) and one expiration (breathing out) (continues)

Measuring and Recording Respirations (continued) Normal respiratory rate Adults: 12-20 breaths per minute Children: 16-30 per minute Infants: 30-50 per minute

Measuring and Recording Respirations Must note 3 different factors: Rate (breaths per minute) Character (depth and quantity) Rhythm (regularity)

Measuring and Recording Respirations (continued) Character of respirations – refers to depth and quality Deep vs. shallow, labored, moist, difficult, noisy Rhythm of respirations – refers to spacing between breaths Regular (or even) vs. irregular

Measuring and Recording Respirations (continued) Abnormal respirations Dyspnea: difficulty breathing Apnea: absence of respirations Tachypnea: rapid, shallow > 25/min Bradypnea: slow <10/min

Measuring and Recording Respirations (continued) Abnormal respirations Orthopnea: severe dyspnea in any position besides sitting or standing Cheyne-Stokes: abnormal breathing pattern, periods of dyspnea and apnea Rales: bubbling or noisy sounds caused by fluid Cheyne stokes – chain stokes

Measuring and Recording Respirations (continued) Voluntary control of respirations Respiration can be controlled if consciously thought about Important to keep the patient unaware breathing is being assessed Do not tell the patient you are counting respirations

Measuring and Recording Respirations (continued) Record information Rate, character, rhythm Ex: A child with R 22, shallow, labored, and regular would suffer from? Ex: An adult with R 8, deep, regular would suffer from? Ex. Tachypnea Ex. Bradypnea

15:5 Graphing Temperature (TPR) Graphic sheets are special records used for recording TPR Presents a visual diagram (easier to follow) Uses – hospitals or long care facilities (continues)

15:5 Graphing TPR Color codes Temperature in blue Pulse in red Respirations in green Factors affecting vital signs are often noted on the graph Surgeries, medications, day & time, etc. (continues)

Graphing TPR (continued) Graphic charts are legal records Must be legible and neat Completed in ink Use straightedge to connect lines HIPAA act! To correct an error: cross out in red ink and correct, initial next to correction

Graphing TPR (continued) Basic principles for completing: Fill in patient information accurately Fill in dates, times (mm/dd/yyyy, __:__am/pm) Adm = admission (first measurement) Following days are numbered PO = after surgery PP = post partum (after delivery)

15:7 Measuring and Recording Blood Pressure Blood Pressure: Measurement of the pressure the blood exerts on the walls of the arteries during the various stages of heart activity Measured in millimeters of mercury (mmHg) on a sphygmomanometer (continues)

Measuring and Recording Blood Pressure (continued) Systolic pressure: pressure when left ventricle contracts and pushes blood to arteries Normal is <120 mmHg (range of 100-120 mmHg) First sound heard during reading of sphygmomanometer

Measuring and Recording Blood Pressure (continued) Diastolic pressure: constant pressure when left ventricle is at rest, or between contractions Normal is < 80 mmHg (range of 60-80 mmHg) Last sound heard during reading of sphygmomanometer

Measuring and Recording Blood Pressure (continued) Blood pressure is read as a fraction Systolic pressure / Diastolic pressure Ex: (120/80 mmHg)

Measuring and Recording Blood Pressure (continued) Pulse pressure: difference between systolic & diastolic pressure Important indicator of health and tone of arterial walls Normal range is 30-50 mmHg The pulse pressure should be approximately one third of the systolic reading (120 - 80 = 40)

Measuring and Recording Blood Pressure (continued) Hypertension—high blood pressure Prehypertension (120-139 mmHg / 80-89 mmHg) Systolic > 140 mmHg / Diastolic > 90 mmHg Hypotension—low blood pressure Systolic < 90 mmHg / Diastolic < 60 mmHg (continues)

Measuring and Recording Blood Pressure (continued) Factors influencing blood pressure readings (high or low) Force of heartbeat Resistance of arterial system Elasticity of the arteries Volume of blood in arteries Position of the patient (standing vs sitting vs lying down) (continues)

Measuring and Recording Blood Pressure (continued) Increased BP Excitement, anxiety, nervous tension Pain Obesity Stimulant drugs Exercise and eating Smoking Decrease BP Rest or sleep Depressant drugs Shock Dehydration Hemorrhage fasting

Measuring and Recording Blood Pressure (continued) Types of sphygmomanometers Mercury: uses a column of mercury in a tube to measure the pressure (discouraged by OSHA) Aneroid: uses a round gauge to measure pressure Each line on gauge = 2 mmHg Measure at eye level, deflated cuff should read zero Electronic: measures pressure automatically Shows reading on a digital display (continues)

Measuring and Recording Blood Pressure (continued) Factors to follow for accurate readings Patient should sit quietly for at least five minutes before BP is taken Two readings should be taken and averaged Minimum wait of 30 seconds between readings Arm should be rested on a flat surface & free of restrictions

Measuring and Recording Blood Pressure (continued) How to measure blood pressure Cuff should be placed above the crook of the elbow, with arrow pointing over brachial artery Place the bell/diaphragm of stethoscope directly over brachial artery in the antecubital fossa Hold as securely as possible with index/middle fingers Inflate cuff to 150-180 mmHg Deflate slowly and listen for heart sounds First sound = Systolic Blood Pressure (Top #) When sound disappears = Diastolic Blood Pressure (Bottom #)

Measuring and Recording Blood Pressure (continued) Record all required information Date, time, BP, signature/initials Do not discuss the reading with the patient; it’s the doctor’s responsibility Could cause personal reaction to patient

Blood Pressure Practice 19: 102/58 18: 142/72 17: 100/60 16: 96/58 15: 128/60